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Objective To explore the diagnostic value of thrombomodulin (TM) for sepsis-induced coagulopathy. Methods A prospective study was conducted on 172 hospitalized patients with sepsis from intensive care units (ICU) of the 908th Hospital of Chinese PLA Logistical Support Force between May 2018 and October 2019. All the subjects were divided into sepsis-induced coagulopathy (SIC) group (n=68) and sepsis alone (SA) group (n=104) according to the diagnostic criteria of International Society on Thrombosis and Haemostasis. Baseline characteristics [gender, age, acute physiology and chronic health evaluationⅡ (APACHE Ⅱ), sequential organ failure assessment (SOFA), mean arterial pressure (MAP), lactate (Lac), comorbidity, ICU mortality and length of stay in ICU], coagulation tests [prothrombin time (PT), international normalized ratio (INR), platelet count (PLT)] and molecular markers of coagulation [tissue plasminogen activator-inhibitor complex (t-PAIC), TM, thrombin-antithrombin complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC)] were compared. Multivariate logistic regression analysis was used to identify risk factors for SIC. The effectiveness of TM in diagnosing SIC was analyzed by ROC curve analysis. Kaplan- Meier analysis was used to analyze the cumulative survival rate. Results Compared with TM [10.5(7.8-14.9) TU/ml], TAT[8.6(4.8-18.0) ng/ml] and t-PAIC [11.6(7.1-22.2) ng/ml] in SA group, TM [15.0(10.5-25.9) TU/ml], TAT [15.1(5.7-34.6) ng/ml]and t-PAIC [22.1(11.0-39.1) ng/ml] in SIC group were significantly increased (P<0.05). Multivariate logistic regression analysis showed that TM and Lac were the independent risk factors for SIC. The area under the curve of TM for diagnosing SIC was 0.685 and its diagnostic threshold was 11.5 TU/ml. Its diagnostic sensitivity, specificity, positive predictive value and negative predictive value were 72.1%, 61.5%, 55.2% and 77.1%, respectively. Kaplan-Meier analysis revealed that the death risk of patients with sepsis in TM >11.5 TU/ml group was 3.61 times higher than TM ≤11.5 TU/ml group. The mortalities of patients who met or didn't meet the ISTH-SIC diagnosis criteria were respectively 47.1%(32/68) and 21.2%(22/104). The mortality of patients with SOFA≥2 and TM>11.5 TU/ml was 47.2%(42/89), while the other patients was 14.5%(12/83). Conclusions Elevated serum TM level could be found in patients with SIC. SOFA combined with TM has a better diagnostic efficacy for SIC.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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